Shows
Behind The Knife: The Surgery PodcastClinical Challenges in Emergency General Surgery: The Abdominal Wall – Friend or Foe?It is the final episode of our Challenging Cases in Emergency General Surgery series and we’re diving into another dreaded topic: the complex abdominal wall. This structure is a daily partner to the general surgeon—but when things go wrong, it can quickly become our biggest challenge. In this episode, we’ll walk through the emergency presentation of a patient with multiple prior hernia repairs and mesh placements, and how these complicate diagnosis and management. From imaging pearls to OR decision-making and post-op dilemmas, this episode covers it all. We round things off with a fun game (as always!) and som...2025-05-1234 minBehind The Knife: The Surgery PodcastClinical Challenges in Emergency General Surgery: Acute Care Surgery ComplicationsIn this episode by the Emergency General Surgery team, we explore the inevitable in acute care surgery- complications. Once a taboo subject, we are now beginning to understand how surgeons and care teams are affected when things don't go as planned. The team discusses two articles that explore the impact of surgical complications on surgeons, both in the short and long term, as well as ways to rehabilitate and support surgeons when they face a challenging complication. Drawing on the article, as well as personal experience, this episode works towards the ongoing shift in surgical culture around outcomes and supports...2024-11-2824 min
Cold Steel: Canadian Journal of Surgery PodcastBonus Episode from CANUCS Surgical Fellows Course: Ashlie Nadler on being Available, Affable, and AbleWe’re really excited to bring you talks that we recorded as part of the CANUCS Surgical Fellows course. CANUCS is a national organization that stands for Canadian collaborative on urgent care surgery. Dr. Chad Ball and Kelly Vogt were instrumental in bringing together some really fantastic speakers to talk about the critical knowledge and skills that surround obtaining a staff job, as well as being successful both personally and professionally in a demanding career. Dr. Ashlie Nadler is an Assistant Professor at the University of Toronto and practices at Sunnybrook Hospital. She has unique training in both...2024-10-1727 minBehind The Knife: The Surgery PodcastClinical Challenges in Emergency General Surgery: Management of Duodenal EmergenciesJoin our Emergency General Surgery team as we talk about the dreaded difficult duodenum. We discuss two cases on a common disease that has now become a rarity in surgical management. We cover principles of combined assessment and resuscitation, diagnosis and helpful adjuncts, and multidisciplinary and surgical management.
Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross
We have come a long way from managing duodenal emergencies with vagotomies since the widespread use of proton pump inhibitors. But surgeons and trainees still need to gain competence in managing duodenal emergencies, despite the dearth of operative interventions...2024-08-1533 minBehind The Knife: The Surgery PodcastJournal Review in Emergency General Surgery: AppendicitisCan appendicitis wait until the morning? Join Drs. Ashlie Nadler, Jordan Nantais, Graham Skelhorne-Gross, and Marika Sevigny from our Emergency General Surgery Team as they discuss the role of deferring appendectomies from overnight to the next morning.
Paper 1: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93.
https://pubmed.ncbi.nlm.nih.gov/37436871/
-Non-inferiority randomized controlled trial comparing delayed appendectomy group with surgery taking place after 0600 the morning following...2024-04-1521 minBehind The Knife: The Surgery PodcastClinical Challenges in Emergency General Surgery: Complicated PancreatitisJoin our Emergency General Surgery team as we talk about a popular and controversial issue in surgery: dealing with complicated cases in pancreatitis. We discuss two hard-hitting cases and cover principles of diagnosis, early management and disposition, and things to look out for every step of the way.
We cover some common and some rare but particularly problematic complications. Although there is no right answer to every case of pancreatitis, we try to help learners to develop an approach to pancreatitis that considers the morbidity and benefits of every option.
Hosts: Drs. Ashlie Nadler, Jordan Nantais...2023-12-1437 minBehind The Knife: The Surgery PodcastJournal Review in Emergency General Surgery: Clostridium Difficile InfectionAn ever-present spectre looming over the hearts of general surgeons everywhere! Please join our Emergency General Surgery team for a journal review about Clostridium difficile (C. diff) infection. Dr. Ashlie Nadler and Dr. Jordan Nantais are joined by guest Dr. Marika Sevigny, recent graduate of trauma and acute care surgery at the University of Toronto, as Dr. Graham Skelhorne-Gross prepares for his upcoming fellowship at Harborview.
Paper 1: Ahmed et al. Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system. Eur J Trauma Emerg Surg. 2022 Jun.
- Risk score development study using...2023-08-0723 minBehind The Knife: The Surgery PodcastClinical Challenges in Emergency General Surgery: Cirrhotic PatientsPlease join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients.
Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality)
· Bilirubin, albumin, INR, ascites, encephalopathy
· Used to predict operative mortality based on cirrhosis severity
· Mortality in EGS:
- Child-Pugh A: 10% electively and 22% emergently
- Child-Pugh B: 30% electively and 38% emergently
- Child-Pugh C: 80% electively and up to 100% emergently
Model for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older)
· creatinine, biliru...2023-04-0333 minBehind The Knife: The Surgery PodcastJournal Review in Emergency General Surgery: Surgical Site ComplicationsThe dreaded Surgical Site Complications! Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross from our Emergency General Surgery Team as they discuss surgical site complications and prevention techniques.
Paper 1: Arnold et. al. (2019) Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP. American Surgeon
- NSQIP database 2005-2016 (>800,000 patients) including open/laparoscopic cholecystectomies, ventral hernia repairs, and partial colectomies
- Comparing outcomes in emergent vs elective cases
- Primary outcome: aggregate of SSIs which includes wound disruption, superficial SSI, deep SSI, and organ space SS...2022-11-1425 minBehind The Knife: The Surgery PodcastClinical Challenges in Emergency General Surgery: Necrotizing Soft-Tissue InfectionsJoin our Emergency General Surgery team as they discuss Necrotizing Soft-Tissue Infections. Hosted by Drs. Jordan Nantais, Ashlie Nadler, Stephanie Mason and Graham Skelhorne-Gross.
Necrotizing Soft-Tissue Infections:
- Also known as “flesh eating disease”, gas gangrene, necrotizing fasciitis/myositis, Fournier’s gangrene.
- Early findings are non-specific
- Rapidly fatal - diagnostic delay can lead to tremendous additional morbidity and mortality
Classification:
- Type 1 - polymicrobial category (most common) found in immunosuppressed or elderly
- Type 2 - monomicrobial infection [Group A Streptococcus > Methicillin-resistant Staphylococcus aureus (MRSA)]
- Type 3 - monomicrobial infect...2022-07-2534 minBehind The Knife: The Surgery PodcastClinical Challenges in Emergency General Surgery: Cancer EmergenciesJoin Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross as they tackle Cancer Emergencies.
Case 1 - Learning Points:
These are complex patients and multidisciplinary care should be provided with input from oncology.
A step-up approach should be used, starting with medical management prior to considering surgery in appropriate patients.
Highly selected patients may benefit from surgery, namely those with a high performance status, a prognosis of months if the bowel obstruction was resolved, minimal carcinomatosis, and a single transition point. Diversion, bypass, or resection are all options, but a patient’s capacity to heal related to recent systemic ther...2021-11-1533 min